Drug-induced nutrient depletion

Azamune & Nutrient Depletion

Also searched as Immunoprin. What the clinical evidence reports, what it may mean, and what to discuss with your pharmacist.

1Nutrient association
Moderate DepletionHighest rating
The bottom line

Azamune has been associated with depletion of NIACIN. This does not mean a deficiency will occur — it means these are worth knowing about and, if you take Azamune long-term, worth raising with your pharmacist or healthcare provider.

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The evidence

Reported nutrient depletions with Azamune

Each record below is shown as published in our licensed clinical database, with its evidence rating and citations. Expand a section for food sources and talking points.

NIACIN

Moderate Depletion

AZATHIOPRINE (Imuran)

Azathioprine might reduce levels of niacin and precipitate niacin deficiency.

Azathioprine is metabolized to 6-mercaptopurine, which is thought to inhibit nicotinamide adenine dinucleotide synthesis. In 2 cases, a pellagrous rash responded to niacinamide 150 mg daily, with or without the discontinuation of azathioprine.
Taking Azamune? Monitor for depletion; a supplement is needed for some patients.
Dr. Brian Staiger, Pharm.D explains

Niacin is a B vitamin your body uses to produce energy and keep your skin, nerves, and digestion working properly. Azamune is broken down in the body into a compound called 6-mercaptopurine, and that byproduct appears to interfere with the way your cells make an important niacin-related molecule, which can gradually reduce your niacin levels. This is rated as a moderate concern, meaning most people will be fine but some long-term users may need attention, especially if a skin rash or other unusual symptoms develop. It is worth bringing up with your pharmacist or doctor, particularly if you have been on Azamune for a while.

What Vitamin B3 (niacin) does & food sources

Niacin supports energy metabolism, skin health, and nervous system function.

Common food sources:

  • Poultry, beef, and fish
  • Peanuts and legumes
  • Fortified grains

HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.

What to discuss with your clinician

Deficiency is rare in a typical diet. Discuss with your provider before using niacin as a supplement — at pharmacologic doses it behaves like a medication.

HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.

Supplement considerations

High-dose niacin causes flushing and can affect the liver, blood sugar, and uric acid — it is not a casual supplement.

Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.

HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.

Caution: Treat high-dose niacin as a medication decision, not a nutrition one.

Learn more about this nutrient: Niacin — uses, safety & interactions

References (1)
  1. Jarrett P, Duffill M, Oakley A, Smith A. Pellagra, azathioprine and inflammatory bowel disease. Clin Exp Dermatol 1997;22:44-5. PubMed
Important

This tool is educational and is not a substitute for professional medical advice. An association is not a diagnosis and does not mean a deficiency will occur. Always talk to your pharmacist or healthcare provider before starting, stopping, or changing any medication or supplement.

Disclaimer: This checker finds which nutrients might be depleted by prescription or over-the-counter medications. Each nutrient depletion issue is rated based on clinical significance. Use your own professional judgment prior to making clinical decisions.

© 2026 Therapeutic Research Center Licensed records refresh weekly · last updated July 3, 2026.
Understand the basics

What drug-induced nutrient depletion means

Some medications can, over time, lower the levels of certain vitamins, minerals, or other nutrients — through reduced absorption, increased loss, or changes in how the body uses them.

Association is not deficiency

An entry here means a depletion has been reported or studied — not that it happens to everyone, or that you are deficient. Dose, duration, diet, and your own health all matter.

Evidence varies by pair

Some drug–nutrient links (like metformin and vitamin B12) are well studied; others rest on limited or preliminary research. Each entry shows the evidence rating from our licensed clinical database.

When to ask about labs

If you take an associated medication long-term, ask your healthcare provider whether monitoring is appropriate for you. Not everyone needs testing — your provider can weigh your dose, duration, and symptoms.

Don't self-supplement blindly

Supplements are not risk-free: some can interact with medications, and some (like potassium or magnesium) can be risky with kidney disease. Talk to your pharmacist before adding anything.

Never stop a medication over this

These medications are prescribed for good reasons, and the benefit usually far outweighs a manageable nutrient consideration. Any change belongs in a conversation with your prescriber.

Food first, usually

For many nutrients, a varied diet covers the gap. Each entry lists common food sources; a supplement is a decision to make with your pharmacist or provider, not a default.

Common questions

Azamune & nutrients: FAQs

Does Azamune deplete NIACIN?
Azamune has been associated with lower NIACIN levels in the clinical literature — see the evidence rating and details above. An association is not a guarantee: dose, duration, diet, and your own health all matter. If you take Azamune long-term, ask your healthcare provider whether checking your NIACIN status is appropriate.
Should I take a supplement because I take Azamune?
Not automatically. The right first step is usually a conversation with your pharmacist or provider — they can weigh your dose and duration, decide whether testing makes sense, and recommend food-first strategies or a supplement if genuinely needed. Some supplements can interact with medications, so do not add one without checking.
Should I stop taking Azamune?
No — never stop a prescribed medication because of a nutrient association. Azamune is prescribed for good reasons, and nutrient considerations are usually manageable with monitoring or diet. Any change to your medication belongs in a conversation with your prescriber.
Where does this information come from?
The depletion records come from the Natural Medicines (Therapeutic Research Center) database — an evidence-graded clinical reference — and are displayed as published, with their citations. The plain-English context is written and reviewed by licensed HelloPharmacist pharmacists.

Questions about Azamune and your nutrition?

Ask a licensed pharmacist — free, no appointment needed.

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Sources

Sources & How We Checked

Nutrient depletion records for Azamune are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.